"Men Trapped in Men's Bodies:"

An Introduction to the
Concept of Autogynephilia

By Anne Lawrence, M.D.

Male-to-female transsexuals are popularly characterized as
"women trapped in men's bodies." And undoubtedly there
are some transsexuals for whom this is an accurate description. But there
are also some of us male-to-female transsexuals to whom this popular
description does not so obviously apply. Many of us transitioned in our
30's, 40's, or even later, after having lived outwardly successful lives as
men. Often we were not especially feminine as children, and some of us
are not especially feminine after transition, either. Many of us were, or
occasionally still are, married to women; often we have fathered children.
A sizable number of us identify as lesbian or bisexual after reassignment.
Many of us have a past history of sexual arousal in association with
cross-dressing. Yet there is no doubt that we can suffer from intense
gender dysphoria, and no less so than our more outwardly feminine
transsexual sisters. And we pursue sex reassignment surgery every bit as
intensely, too.

Is there a more accurate way to characterize those of us who knew
we were male anatomically, who were not outwardly feminine and
sometimes had to work rather hard to appear feminine, yet who intensely
wanted to be women? I have sometimes half-jokingly said that we were
"men trapped in men's bodies." I do not use this
expression disparagingly. Many of my closest friends come from the
background I have described; and in most respects it is my background as
well. (I also acknowledge that some persons fitting the above description
would emphatically deny that they were ever "really" men, and
I have no quarrel with their self-definition.) While it takes tremendous
courage for anyone to undergo gender transition, this seems to be
especially true for those of us whose presentation may not be
"naturally" feminine, and whose years of male privilege have
often resulted in our having a great deal to lose.

It is not difficult to understand why biologic males who have been
extremely feminine ever since childhood, and who are sexually
attracted to men, would seek sex reassignment surgery. It is more
difficult to understand why males who are attracted to women, who have
been fairly successful as men, and who do not appear remarkably feminine
would do so. What force is powerful enough to make us give up our whole
place in the world; to make us risk estrangement from our families, loss
of our jobs, and rejection by our friends?

I know of only one force that powerful. To see that force in
action -- and its ability to make otherwise prudent souls throw
caution to the wind -- one need look no further than to the current
American President. The force in question is one designed by nature to be
terrifically powerful, because it is necessary to ensure the survival of our
species. That force is, of course, sexual desire.

Naturally it flies in the face of conventional wisdom to assert that
transsexuality has anything to do with sexual desire. Everyone knows
that, although sexual orientation or "affectional preference"
may be about sex, transsexuality is about gender. We transsexuals
transition because we're transgendered, because we desperately
want to live in the opposite gender role. In fact, it's not even
politically correct to talk about "sex reassignment surgery"
anymore; the politically correct term is "gender reassignment
surgery" or even "gender confirmation surgery."
This is to emphasize -- according to the theory -- that the quest for the
sought-after gender role is primary; and that sex reassignment
surgery is not an end in itself, but is merely a confirmation of our
gender transition.

Unfortunately, there are a few troublesome people who are inclined
to doubt the conventional wisdom. Some of them are clinicians who
work with transsexual clients, and who find that the conventional wisdom
fails to explain much of what they observe. And a few of these
troublesome people are transsexuals themselves -- unusually candid
transsexuals, who are not shy about saying that sexual desire was a
significant motivation in their transitions. To understand what these
people are getting at requires making the acquaintance of a seven-syllable
word derived from Greek: "autogynephilia."

The term autogynephilia was coined in 1989 by Ray Blanchard,
a clinical psychologist at the Clarke Institute of Psychiatry in
Toronto. He defined autogynephilia as "the propensity to be sexually
aroused by the thought or image of oneself as a woman." In a
remarkable series of papers published between 1985 and 1993, (1)
Blanchard explored the role of autogynephilia in the erotic lives of
hundreds of male gender dysphoric patients.

Blanchard hypothesized that there are two fundamentally different
types of gender dysphoric males: those who are exclusively or almost
exclusively aroused by men, i.e., who are androphilic; and all
the rest, who, as it turns out, are primarily aroused by the idea of
being women, i.e., who are autogynephilic.

Blanchard studied over 200 male subjects who presented for
evaluation at the Clarke Institute, saying that they felt like (or
wanted to be) women. He found that the gender dysphoric males who were
primarily attracted to men -- those with what he called
androphilic or homosexual gender dysphoria --
presented for initial evaluation at a relatively early age. (Note that the
term "homosexual" here refers to attraction to someone of the
same biologic sex. This is the conventional usage in the psychiatric
literature. Also by convention, this usage does not reverse
following sex reassignment surgery: a postoperative male-to-female
transsexual who is attracted to men is still called
"homosexual"). Blanchard's homosexual gender dysphoric males
usually reported having been very feminine as children. Only about 15% of
them gave any history of sexual arousal with cross-dressing. And they
generally were not sexually aroused by fantasies of simply being
female. What primarily aroused them were men -- especially men's
bodies.

The other group of gender dysphoric males was more diverse,
and included: those attracted primarily to women (heterosexual or gynephilic); those attracted to both women and men
(bisexual); and those with very little attraction to other
persons of either sex (anallophilic, "not attracted to
other people"). Collectively these persons were said to have a
non-homosexual type of gender dysphoria. Blanchard found
that the males in this group presented for initial evaluation at a
somewhat later age. They reported less childhood femininity, and in fact
they often appeared to have been unremarkably masculine as children.
About 75% of them admitted to sexual arousal with cross-dressing. And,
most significantly for Blanchard's theory, they were almost always
intensely aroused sexually by autogynephilic fantasies -- simply by the
idea of being women. Subsequent studies using penile
plethysmography further demonstrated that many of those who had denied
arousal to cross-dressing actually did become aroused while listening to
spoken descriptions of cross-dressing scenarios. (2)

Autogynephilia can be seen as a type of paraphilia,
although Blanchard has sometimes been reluctant to say this
unequivocally, for reasons I will discuss below. Paraphilias are defined in
DSM-IV as:

The unstated assumption here is that "normal,"
non-paraphilic sexuality necessarily involves arousal primarily toward
other people. Therefore arousal which is primarily toward a
fantasized or actual aspect of oneself, or of one's own behavior, in
which other people may be present but are essentially superfluous, is in
principle equivalent to arousal involving a "non-human object."

What makes the issue complicated is that autogynephilia does not
necessarily preclude attraction to other people. That is why one can
say that some transsexuals are autogynephilic, and simultaneously
categorize them as heterosexual, bisexual, or anallophilic. (If
autogynephilia completely precluded attraction to other people, all
autogynephilic persons would be anallophilic.) But autogynephilic arousal
often does seem to compete with arousal toward other people. For
example, autogynephilic persons who are heterosexual or bisexual often
report that when they first become involved with a new sexual partner,
their autogynephilic fantasies tend to recede, and they become more
focused on the partner. But as the relationship continues, and the novelty
of the partner wears off, they more frequently return to autogynephilic
fantasies for arousal. (Perhaps for biologic males, novelty is an important
factor in determining which of several possible sources of arousal
receives attention.)

Another common observation made by autogynephilic persons is
that, while they like having partnered sex, there is sometimes a way
in which their partner is almost superfluous, or merely acts as a kind of
prop in an autogynephilic fantasy script. Blanchard has observed that this
is especially characteristic of many autogynephilic fantasies involving
male partners: often the male figure is faceless or is quite abstract, and
seems to be present primarily to validate the femininity of the person
having the fantasy, rather than as a desirable partner in his own right. In
part because autogynephilia seems to compete with attraction toward
other people, but without precluding it, Blanchard has sometimes
preferred to call autogynephilia an "orientation," rather than a
paraphilia. (4)

Blanchard distinguished four different types of autogynephilia in his
subjects, although many individuals demonstrated more than one type.
The first type is transvestic autogynephilia, in which the
arousal is to the act or fantasy of wearing women's clothing. The second
is behavioral autogynephilia, in which the arousal is to the
act or fantasy of doing something regarded as feminine, e.g., knitting with
other women, or going to the hairdresser's. The third is physiologic
autogynephilia, in which the arousal is to fantasies such as being
pregnant, menstruating, or breast-feeding. The final type is
anatomic autogynephilia, in which the arousal is to the
fantasy of having a woman's body, or aspects of one, such as breasts or a
vulva.

Blanchard thought it was entirely predictable that biologic males
who experienced sexual excitement at the idea of having a woman's
body would in fact seek to acquire or inhabit such a body. And his research
subsequently confirmed that his subjects with the anatomic type of
autogynephilia were the ones most interested in physical transformation,
i.e., in sex reassignment surgery. He summarized his theory this way:

"Autogynephilia takes a variety of forms. Some men are
most aroused sexually by the idea of wearing women's clothes, and they
are primarily interested in wearing women's clothes. Some men are most
aroused sexually by the idea of having a woman's body, and they are most
interested in acquiring a woman's body. Viewed in this light, the desire
for sex reassignment surgery of the latter group appears as logical as the
desire of heterosexual men to marry wives, the desire of homosexual men
to establish permanent relationships with male partners, and perhaps the
desire of other paraphilic men to bond with their paraphilic objects in
ways no one has thought to observe." (5)

I consider this to be one of the most brilliant and insightful analyses in
the entire clinical literature devoted to transsexuality.

It is worth emphasizing that Blanchard's theory refers to sexual
desire in a fairly broad sense; it means more than just genital arousal.
In fact, Blanchard was quite aware that his theory about non-homosexual
transsexuality being a manifestation of sexual desire would have to
explain why the transsexual impulse persists even when genital arousal is
reduced or absent. For example, many of us with a history of sexual
arousal to cross-dressing or to other autogynephilic imagery report that
while our sexual excitement diminishes over time, our desire for sex
reassignment surgery continues and even intensifies. Likewise, when we
autogynephilic transsexuals take estrogen, our libido is often diminished
or even eliminated, but our desire for sex reassignment usually is not.
Blanchard hypothesized that after a period of time, stimuli which have
been experienced as sexually exciting come to be regarded as rewarding
and desirable in their own right, even when they no longer evoke intense
genital arousal. Again using the analogy of heterosexual marriage,
Blanchard pointed out that men often continue to experience intense
emotional bonds to the objects of their sexual desire (i.e., their wives),
even after their initial intense sexual attraction has diminished or
completely disappeared.

Moreover, we do not have to deny that sex reassignment has other
rewarding aspects in order to accept the idea that, for many of us,
sexual desire is the origin and the kernel of our transsexual impulse. The
qualities we need to cultivate to live successfully in female role can be
very rewarding in their own right. Learning to embody such feminine traits
as gentleness, empathy, nurturance, and grace improves the quality of our
lives, and simply makes us better human beings. Many of us happily
discover a number of genuine non-sexual reasons for wanting to undergo
sex reassignment. Therefore it becomes easy -- and not necessarily
inaccurate -- to tell ourselves and everyone else that we genuinely do
want to transition for reasons which have nothing to do with sexual
desire. Yet many if not most of us would probably have to admit, if we
were honest, that sexual motivations were at least originally at the heart
of our desire to transition -- and that they are probably still there,
lurking not far beneath the surface.

It would be a mistake to conclude that if autogynephilic
transsexuality is in large part about sexual desire, then it is somehow
suspect, or is less legitimate than homosexual transsexuality.
Although the focus of this essay is not on homosexual transsexuality
per se, I do want to say enough about it to dispel any mistaken
notions that homosexual transsexuals are the "real"
transsexuals, or that their motivations are exclusively non-sexual.
Neither is true. By definition, transsexuals are those who undergo sex
reassignment as a treatment for gender dysphoria. The gender dysphoria of
autogynephilic transsexuals is every bit as real as that of their
homosexual counterparts. And it matters not a whit if that dysphoria
stems in whole or in part from an inability to achieve sexual satisfaction
in one's existing body or role. Autogynephilic transsexuals have just as
much claim to being "real" transsexuals as their homosexual
sisters.

And homosexual transsexuals are not exactly devoid of sexual
motivations themselves. Colleagues who have spent a lot of time
interviewing homosexual transsexuals tell me that they can best be
thought of as very effeminate gay men who do not defeminize in
adolescence. Nearly all go through a "gay boy" period; and their
decisions about whether or not to transition are often based in large part
on whether they expect to be sufficiently passable in female role to
attract (straight) male partners. Those who conclude they will not pass
usually do not transition, no matter how feminine their behavior may be.
Instead they accept, perhaps grudgingly, a gay male identity, and remain
within the gay male culture, where they can realistically expect to find
interested partners. This self-selection process explains the intriguing
observation that transitioning homosexual transsexuals tend to be
physically smaller and lighter than their autogynephilic sisters. (6) The
bottom line is that in homosexual transsexuality, too, a sexual calculus is
often at work. Transsexualism is largely about sex -- no matter what kind
of transsexual one is.

Although Blanchard's research was rigorously performed, it is also
important to understand its limitations. First, it was conducted on a
clinical sample: a group of males sufficiently distressed or symptomatic
that they chose to be evaluated. Second, in order to partition his subjects
into categories based on sexual attraction, Blanchard used a deliberate
seeding technique to ensure that four clusters would result. While this
may be useful and valid for statistical purposes, a look at the graphic data
reveals that the clusters are not really that distinct. The bisexual and
homosexual clusters are particularly arbitrary in their separation, which
argues against any rigid typology, and suggests the hypothesis that at
least some bisexual transsexuals might comprise an intermediate type.
Third, at the risk of stating the obvious, Blanchard merely found
statistical correlations, albeit highly significant ones, between several of
the variables he examined. This does not imply that the patterns he
discovered will necessarily hold true in any particular individual case.
There will always be exceptions. Finally, none of Blanchard's subjects had
actually undergone gender transition and sex reassignment surgery -- they
were simply males who were gender dysphoric, and who said they felt like
they were, or wanted to be, women. Blanchard has never tested his ideas
in a group of postoperative male-to-female transsexuals.

I tried to confirm Blanchard's theories among a group of
postoperative transsexual women at the 1996 and 1998 New Woman's
Conferences, using an anonymous survey method. In 1996, ten out of
thirteen of the women, fully three-quarters, said that "
self-feminization was erotic" for them. And over half of the women
said that "self-feminization had been their primary erotic fantasy
prior to transition." (7) In 1998, somewhat better prepared, I asked a
question specifically written by Blanchard. In answer to it, five of eleven
women, nearly one half, agreed that before surgery, their "favorite
erotic fantasy was that they had, or were acquiring, some features of a
woman's body." (8) Additional evidence for the importance of
autogynephilic fantasy in transsexuals who have actually undergone
surgery comes from Maryann Schroder's unpublished Ph.D. thesis,
"New Women." Five of her seventeen postoperative subjects
described having been aroused by autogynephilic sexual fantasies prior to
surgery. (9)

Why is it that autogynephilia, which is so readily reported in these
small groups of postoperative women, has received so little
attention? I think there are several reasons.

Among transsexuals, autogynephilia is not quite respectable as a
topic for discussion. For one thing, many transsexuals have a
passionate dislike for the Clarke Institute, and tend to dismiss out of hand
any findings that have come from it. Therefore Blanchard's ideas are not
often talked about; and when they are raised, they tend to get shouted
down. Shame is undoubtedly another deterrent. It is probably just too
threatening for many transsexuals to admit that they have had
autogynephilic fantasies, and especially to admit that autogynephilic
sexual desire may have been one of their motivations for seeking sex
reassignment surgery. People are understandably reluctant to admit to
having a paraphilia -- more popularly known as a perversion. Most
transsexual women want to be seen as a "real women," and it is
widely understood that paraphilic arousal is almost exclusively confined
to men. Transsexuals who admit to autogynephilic arousal may not be seen
as "real women" -- and may not even be seen as
"real" transsexuals!

Therapists and surgeons undoubtedly have their own reasons for
ignoring autogynephilia. Most therapists are accustomed to thinking
about transsexuality using more traditional, gender-based formulations.
The idea that there may be sexual motivations for transition may seem to
them "untidy," and not consistent with their paradigm.
Accordingly, they may think that autogynephilic sexual desire in
transsexuals is rare and aberrant. And since their clients are often
unwilling to talk about their autogynephilia, who can blame the therapists
for thinking so? Moreover, most therapists and surgeons would probably
find it difficult to acknowledge that when they give approval for sex
reassignment surgery, or perform it, they are sometimes simply helping a
transsexual woman act out her own paraphilic sexual script.

Personally, however, I do not find the idea that transsexual women
sometimes seek SRS for sexual reasons to be especially problematic,
even when that sexuality is essentially paraphilic. The real question is not
what one's motivation might be, but whether sex reassignment surgery
improves the quality of one's life. The overall level of satisfaction
following SRS is extremely high. And the evidence thus far seems to
demonstrate that those transsexual women whom one would expect to be
autogynephilic -- late onset, sexually attracted to women, etc. -- tend to
do about as well after surgery as those who present younger and who are
sexually attracted to men.

Certainly no one should be shocked to learn that there are people
who want to modify their bodies -- surgically and in other ways --
primarily to enhance their sexual attractiveness, to themselves or to
others. This is a billion dollar industry in the United States alone, and
most of it does not involve transsexuals. We routinely cut, color, tattoo,
pierce, augment, reduce, lift, tuck, rearrange and contour parts of our
bodies to express our sexuality and to enhance our sexual satisfaction. Nor
is this unique to modern Western culture, as any anthropologist can tell
you. I am not suggesting that we should be complacent about SRS, or
regard it as a casual undertaking. I am suggesting that, to my mind, having
sexual motivations for seeking SRS does not pose any kind of unique
ethical problem. Sexual motivations underlie a vast range of medical and
surgical procedures which are routinely performed on non-transsexuals,
and which we more or less take for granted.

Recently some exceptionally brave transsexual women have been
calling for more candor about the role of sexual motivations in our
life paths. Jessica Xavier wrote this in her article "Reality
Check," published in 1995:

"To become fully cognizant of our realities, we must
first acknowledge our fantasies. The eroticism of crossdressing and
transsexuality for many of us is based upon a powerful sexual fantasy of
becoming someone else, either temporarily or permanently. Why must we
view our own essential eroticism as less than a valid means of
self-pleasure and self-discovery? Sex is a powerful but seldom-discussed
influence in our transgendered lives.... It is both ironic and unfortunate
that our own gender education efforts to date have obscured this essential
eroticism." (10)

Margaret O'Hartigan put it more bluntly in her article
"Surgical Roulette," published in 1994:

"It is necessary for transsexuals to stop pretending that
changing sex is about gender and not about sex. 'Transgenderism' used as a
euphemism for changing sex masks the reality that transsexuals seek to
change their bodies in order to experience genital sexual pleasure without
a prick getting in their way. The recent attempt by some to replace the
term 'sex-reassignment surgery' with 'gender confirmation surgery' only
further confuses the separate issues of sex and gender."
(11)

I think that honest expressions such as these are not only healthy,
but are extremely valuable. Such candor helps transsexual women
whose experiences don't fit the traditional pattern to feel less isolated,
less alone. It is unfortunate, in my opinion, that transsexual women have
not written more extensively about their sexual feelings and fantasies,
and about how these relate to their decisions to pursue transition and
surgery. Carol Christ wrote the following about non-transsexual women,
but it applies to transsexual women equally well:

"Women's stories have not been told. And without
stories there is no articulation of experience. Without stories a woman is
lost when she comes to make the important decisions of her life. Without
stories she cannot understand herself." (12)

Transsexual women's stories need to be told, and heard.
Elsewhere in these pages, I have encouraged readers who have experienced
autogynephilic sexual fantasies or arousal to write to
me, describing their feelings and discussing what role sexual desire
has played in their decisions to transition and to have genital surgery. I
hope to make such material more widely known, so that all those
concerned with transsexuality, both consumers and clinicians, can better
understand the complex relationship between transsexuality and sexual
desire.

I'll close with a true story, about a friend I'll call Linda (not her
real name). Linda transitioned in her late forties, following a very
successful professional career. While living as a man she had been married
to a woman, and had fathered a son. Linda took to female role like a duck
to water, and was soon passing effortlessly. She has SRS with an
excellent American surgeon, known for his skill at preserving sexual
feeling. After surgery she began dating men, and met with some success.
Only one problem continued to bother Linda: In the two years following her
surgery, she had never been able to have an orgasm. One day I ran into
Linda at a conference, and she pulled me aside with a conspiratorial grin:

"I finally had one! The Big O!" "That's
wonderful, Linda," I replied. "How did you do it?"
"It was simple, really. I finally found the right fantasy."
"And that was...?" "Forced feminization."

*********************************************

If there is a moral here, I think it is that knowing and accepting
our own truth is what sets us free.

REFERENCES:

1. The following is a bibliography of articles by Ray Blanchard
concerning autogynephilia: